Jump to Content
 

Available Forms

Medicare Shared Savings Letter

Cary Adult Medicine is participating in the Medicare Shared Savings Program with Wake Med Key Community Care. Please submit the form once you have had an opportunity to review the form

Please use the space above for any additional questions about Cary Adult Medicine's participation in the Medicare Shared Savings program.
 
If you wish to not allow Medicare to share your information between your doctors please complete the opt-out form and return it to Cary Adult Medicine and check this box
 

Preventative Care

Please check the box if you have not had your pneumococcal pneumonia shot after age 65
 
Please check this box if you have not had a mammogram within the past two years and are a female under age 75
 
Please check this box if you have not had a colonoscopy within the past 10 years or you are due for a colonoscopy because polyps were found at your last colonoscopy
* Required field